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Breast cancer презентация
Содержание
- 1. Breast cancer
- 2. The most frequent cancer in women
- 4. Ashkenazi Jewish 1:40, compared with 1:500 in the general population
- 5. + prostate and pancreatic
- 8. Cowden’s syndrome Hamartomas on the skin and
- 12. Irradiation for the treatment of Hodgkin lymphoma before age 30 years.
- 14. Magnitude of Risk of Known Breast Cancer Risk Factors
- 15. + PBSO
- 16. Prevention for BRCA patients Tam ↓contralater
- 17. Chemoprevention with Tamoxifen + RR 50% (0.51)
- 21. BC Receptors
- 22. BC Receptors
- 23. Biological subtypes
- 24. Staging
- 25. DS Mammography US MRI CT
- 27. Surgery In the patient with clinical stage
- 28. Axilla ALND SLNB (less lymphedema) -
- 32. Adjuvant radiation therapy: 5 - 6.5 weeks
- 33. Postmastectomy RT All women with > 3
- 37. For 1 year every 3 weeks
- 38. Neoadjuvant chemotherapy Indications T4 cN pos Inflamatory
- 43. Herceptin +/- Pergeta (Trastuzumab+/- Pertuzumab) & CMT Her 2 pos BC
- 44. Lapatinib Her 2 pos BC A
- 45. Trastuzumab emtansine (TDM1= KADCYLA) Her 2 pos BC Trastuzumab emtansine
- 46. Inflammatory BC T4 1% to 5% of
- 47. Paget disease 1 to 4.3% of all
- 48. Thank you.
The most frequent cancer in women
Слайд 8Cowden’s syndrome
Hamartomas on the skin and mucous membranes.
Enlarged head, a rare
noncancerous brain tumor called Lhermitte–Duclos disease
Слайд 16Prevention for BRCA patients
Tam ↓contralater - 40-50%,
↓ Risk
BC in unaffected only in BRCA 2 (started from age 35)
PBSO -↓OC up to 90-%.
↓ BC -50% (before age 50)
BME ↓ BC 90%
PBSO -↓OC up to 90-%.
↓ BC -50% (before age 50)
BME ↓ BC 90%
Слайд 17Chemoprevention with Tamoxifen
+
RR 50% (0.51) (47 treated - 1 BC prevented)
ADH
- RR 84%
LCIS – RR 40%
↓ 30% bone fructures
LCIS – RR 40%
↓ 30% bone fructures
-
PE (>50y)
Flashes
Endometrial Ca (mostly >50y)
Слайд 26
Systemic therapy:
Hormonal therapy
Chemotherapy
Targeted therapies
Local therapy:
Surgery
Radiation therapy
Treatment of breast cancer
Слайд 27Surgery
In the patient with clinical stage I, II, and T3N1 disease,
the initial management is usually surgical.
BCT : Lumpectomy + RT = Mastectomy
Contraindications for BCT:
- Previous RT
Pregnancy
Widespread disease
Pos margins
Tumors >5 cm, small breast
BCT : Lumpectomy + RT = Mastectomy
Contraindications for BCT:
- Previous RT
Pregnancy
Widespread disease
Pos margins
Tumors >5 cm, small breast
Слайд 28Axilla
ALND
SLNB (less lymphedema)
- Majority of stage I-II BC pts
-
Contraindications to the procedure: pregnancy, lactation, and locally advanced breast cancer.
Слайд 32Adjuvant radiation therapy:
5 - 6.5 weeks
Local control rates > 90%
Minimal toxicity
Adjuvant
radiation therapy – for everyone after
lumpectomy
lumpectomy
Слайд 33Postmastectomy RT
All women with > 3 positive nodes.
All women with any
positive node and a tumor larger than 5 cm.
Women with recurrent positive margins
? Women with T3N0
? Women with 1-3 positive nodes and T1/T2.
Women with recurrent positive margins
? Women with T3N0
? Women with 1-3 positive nodes and T1/T2.
Слайд 38Neoadjuvant chemotherapy
Indications
T4
cN pos
Inflamatory BC
Rationale
Tumor shrinkage
Opportunity for BCS
Early treating of micrometastasis
Aggressive biological
subtypes ---- high rate of PCR (associated with better prognosis)
Слайд 44Lapatinib
Her 2 pos BC
A tyrosine kinase inhibitor
A potent and selective
oral dual inhibitor of ErbB1 (EGFR) and ErbB2 (HER2)
Approved by FDA March 13, 2007
In combination with capecitabine
Approved by FDA March 13, 2007
In combination with capecitabine
Слайд 46Inflammatory BC
T4
1% to 5% of all cases
Aggressive
Neoadjuvant CMT +/- RT
Surgery is
contraindicated in IBC unless there is complete resolution of the inflammatory skin changes.
Слайд 47Paget disease
1 to 4.3% of all breast cancers
Ca in situ in
the nipple epidermis.
Paget cells (large cells with clear cytoplasm and atypical nuclei) within the epidermis of the nipple.
(1) associated with invasive cancer (staged by the invasive cancer)
(2) with underlying DCIS (Tis)
(3) alone (Tis).
Paget cells (large cells with clear cytoplasm and atypical nuclei) within the epidermis of the nipple.
(1) associated with invasive cancer (staged by the invasive cancer)
(2) with underlying DCIS (Tis)
(3) alone (Tis).
